What Boaters Need To Know About Concussions

By Brian Mistrot

Knowing the facts about a common onboard head injury can prevent life-threatening consequences.

Photo: Thinkstockphotos.com/Alex-MIT

Concussion Symptoms

A concussion is a traumatic brain injury. Some people will exhibit all of the following typical signs and symptoms; others only a few — or, in some cases, none at all. Also, be alert for delayed symptoms. The safest course of action: After a severe hit to the head, get checked by the nearest doctor. If you're not near medical help, seek medical advice via cellphone (many health-insurance companies have toll-free helplines) or marine radio.

Eyes dilated or pupil size uneven

Dazed, slow response, confusion

Difficulty concentrating

Amnesia

Irrational anger

Strong sensitivity to light

Severe headache or pressure in head

Vertigo, dizziness

Nausea/vomiting

Slurred speech

Delayed response to questions

Fatigue, strong urge to sleep

Temporary loss of consciousness (does not always occur)

Ringing in ears

Symptoms that can be delayed by hours or days after injury:

Concentration/memory problems

Irritability

Sensitivity to light and noise

Sleep disturbances

Depression

Taste and smell disorder

Source: Mayoclinic.com

It was a beautiful day in the Florida Keys: bright sunshine, light winds, and the gentle hum of the air conditioner running below. It was one of the few times Sea Mist IV, our 40-foot Catalina had been tied to a dock or at a marina in nearly a year; we normally keep the boat on an anchor or mooring. My wife Christie and I were busy preparing the boat to head across to the Bahamas and Caribbean, trying to complete a long list of maintenance jobs before departure.

High on our list was repairing the bimini and dodger; years of cruising had taken their toll. A shop near the marina had agreed to do the job quickly. On Sea Mist, the bimini and dodger typically block the boom — our heads are protected while they're up. After years of living aboard, we'd become accustomed to the layout, instinctively knowing where and when to duck or grab for handholds. But in the process of removing the bimini for repair, I exposed the boom. Reverting to habit, I stood directly up. My head hit the boom with enough force to rattle the rigging. I didn't pass out. I just stood there a moment, shaking off a brief blackness. I felt my head to see if it was bleeding. It wasn't. With a few choice words, I got back to removing the canvas.

With bimini in hand, I disembarked and began walking toward the repair shop. Twenty steps from the boat, I got a crushing headache. It radiated from my temples and eyes, like someone was squeezing my skull. I took a few more steps, and the concrete walkway began moving. A moment later, I had terrible nausea. I turned around and stumbled back to the boat. I'd hardly made it aboard when I was struck by an overwhelming urge to sleep. Unable to think rationally, I was certain I was coming down with a severe cold or flu. I told Christie that I wasn't feeling well, dropped into my berth, and passed out. I didn't wake up for the rest of that day or night.

The next day, I had the worst headache of my life. I crawled out of my berth and closed every blind in the boat — the light made the pain worse. Christie became extremely concerned and promptly got me to a doctor. It turns out I didn't have a cold or flu; I'd suffered a concussion. The doctor gave me a stern scolding for not having sought medical help immediately. My only defense: I truly hadn't realized how serious it was.

"But how could I have suffered a concussion?" I asked. "I wasn't knocked out. I wasn't bleeding from my eyes or ears. Isn't that what's supposed to happen?" Her answer was firm and emphatic. "No!" she said. "You don't have to be knocked unconscious. Many people aren't."

It's now been some three years since my accident, and I've learned a lot about concussions (see "Lessons Learned The Hard Way" below). I still get headaches and spells of vertigo, brought on by watching movies or television, but I'm thankful to be alive. I'd choose the view from my cockpit over television any day. Now I have even more reason to gaze across the water ... and to share the lessons I've learned with others.

Lessons Learned The Hard Way

Most people, especially if it's a first concussion or not severe, will only suffer mild symptoms for a few weeks before returning to normal. Others may have to live with some of the effects permanently. Whether it's a slippery deck, an untimely jibe, or a seemingly simple accidental bump on the head, boaters are extremely vulnerable to this potentially life-threatening injury. Often, we're hours away from medical assistance — or less inclined to rush to a doctor. This can make a concussion even more dangerous.

Remember: Even if a person has not blacked out, a possible concussion cannot be ruled out. Signs and symptoms are not always immediate. The person affected may not think rationally, including not realizing he or she has suffered a concussion.

According to Andrew Nathanson, M.D., a clinical professor of emergency medicine at Brown University in Rhode Island, if the person has unequal or dilated pupils, profoundly altered level of consciousness, or is not easily woken, "chances are very high that there is bleeding in the brain, which is obviously more severe than a just a concussion, and these folks should be evacuated immediately." Boaters on blood thinners, such as Coumadin, Plavix, or Pradaxa, are at high risk of bleeding in the brain with even relatively minor head trauma.

"There is no accepted treatment for a concussion," Nathanson says. "Those who've had a concussion are more prone than the general population to have another one."

Brian Mistrot lives aboard Sea Mist IV, a 40-foot Catalina, with his wife, Christie, and their two sons, Chase and Glen.